In-Pharmacy Asthma Testing Next?

Robert DavidsonEditor-in-Chief

US Pharm. 2018;43(7):1.

Add asthma testing to the possible future repertoire of services available at pharmacies. Last month, using RNA sequencing and machine learning, scientists from the Icahn School of Medicine at The Mount Sinai Hospital in New York revealed that they found a genetic asthma biomarker detectable with a nasal brush test and simple follow-up analysis.

Widespread pickup by doctors, and perhaps pharmacists, seems likely. The inexpensive test can accurately pinpoint mild-to-moderate asthma and differentiate it from allergic rhinitis, smoking, upper respiratory infection, cystic fibrosis, and other respiratory conditions. The research team comprising clinical and computational scientists in the Department of Genetics and Genomic Sciences, the Icahn Institute for Genomics and Multiscale Biology, and the Department of Pediatrics published the results in June in Scientific Reports.

“Mild to moderate asthma can be difficult to diagnose because symptoms change over time and can be complicated by other respiratory conditions,” said Dr. Supinda Bunyavanich, physician and researcher at the Icahn School of Medicine. “Our nasal brush test takes seconds to collect—for time-strapped clinicians, particularly primary care providers at the frontlines of asthma diagnosis, this could greatly improve patient outcomes through early and accurate diagnosis.”

Presently, the most reliable test for asthma is pulmonary function testing, but the training required to administer the complex test and access to the equipment itself are not always available in primary-care settings. The nasal brush and later asthma biomarker analysis, on the other hand, produce a simple binary result—it’s either asthma or not asthma.

To develop the innovative test, scientists applied machine-learning algorithms to the genetic data acquired from nasal brushes of patients with and without asthma. Coupled with machine learning, robust data collection identified a 90-gene biomarker denoting asthma. The next step in moving the test closer to clinical practice, said Dr. Bunyavanich, is a study in a larger population of patients.

“With prospective validation in large cohorts, our asthma biomarker could lead to the development of a minimally invasive test to aid asthma diagnosis at clinical frontlines where time and resources often preclude pulmonary function testing,” she said.

The potential utility of such a test is tantalizing. As described by Troy J. Smith, PharmD, BSChE, in this month’s cover article, “A Pharmacist’s Review of Asthma” (page 15), the respiratory disease is significantly undertreated. “It is estimated that nearly one-half of all asthma patients do not have proper control over their condition,” he writes. “Patient education remains the most crucial element for achieving the desired goals of treating and managing asthma.”

As is the case with other chronic medical conditions, frequent contact with accessible, informed pharmacists could go a long way toward helping patients control this lifelong disease. What better way than a pharmacy-based testing tool to build pharmacist-patient interaction?